Diabetes Having gestational diabetes (diabetes in pregnancy), does not prohibit exercise. With your doctor's guidance, exercise at low and moderate levels is recommended to maintain blood sugars and insulin balance. You should have two doctors monitoring you, your obstetrician and your diabetes doctor (usually your internist, endocrinologist, or diabetologist). Blood sugars should be closely monitored when first starting the exercise, and you should have a snack available at all times. If you have diabetes, exercise sessions should not last more than 30 minutes unless you check and maintain normal blood sugars. Scheduling an appointment with a nutritionist who is a certified diabetes educator (CDE) is recommended to assist with evaluating and meeting your nutritional needs. This service is usually covered by health insurance. Drinking plenty of fluids is also especially important in diabetes and pregnancy.

Numbness Numbness is a symptom that can occur in different areas of the body, including wrists and hands, feet, and occasionally the stomach and thighs. Patterns of numbness follow the path of nerves. Carpal tunnel syndrome, one of the most common causes of numbness, is hand and finger numbness, tingling, and pain. It is not known exactly why this occurs during pregnancy, but fluid retention is thought to contribute. To make sure these symptoms do not worsen, see a specialist if you have numbness with pain or problems lasting longer than one week. Wearing a wrist splint at night and during daily activities might be all you need to solve the problem. Carpal tunnel syndrome of pregnancy also responds to icing, stretching, and occupational therapy if the symptoms are severe. Additional vitamin B6 can also help (ask your doctor before taking this). Carpal tunnel syndrome usually resolves a few months after pregnancy, although it can sometimes be made worse with child-care activities.

Leg Cramping Leg cramping at night can be a common irritant during pregnancy. As long as the cramping goes away and is not accompanied by severe back pain or cramping elsewhere, leg cramps are not a sign of anything serious. Stretching or getting up and walking around usually relieves them. Stretching your legs before bed also can help. Sometimes, cramping is a sign that you are not eating enough salt, potassium, or calcium (see chapter 13, "Exercise Problems and Injuries"). Sports drinks are a good source of potassium and salt. You can also try taking an extra dose of calcium at bedtime.

Sore Breasts/Nipples/Belly ButtonTender and swollen breasts can occur early in pregnancy and cause discomfort during exercise and activities. Make sure you wear a supportive, well-fitting athletic bra to prevent irritation. As the pregnancy progresses, soreness of the belly button can also occur and cause discomfort when it rubs against your clothes during activities. Applying a large Band-Aid to belly button can help. If you are nursing, wear your supportive maternity bra and use lanolin on your nipples to ease the dryness.

Varicose Veins/Leg SwellingVaricose veins can be common in pregnancy, although regular exercise makes them less likely. They can cause both lower leg and thigh tightness and pain, especially when standing. If varicose veins and swelling are a problem, consider taking up swimming (with a flutter kick). Moving your feet up and down and in circles throughout the day and elevating them as much as possible is also helpful. Support stockings not only help with symptoms but also prevent worsening of the varicosities. Under no circumstances should you take diuretics!

Poor Sleep During the first and third trimester, pregnancy is infamous for interfering with sleep. Factors include breast and abdominal discomfort, leg cramps, baby's movements and having to go to the bathroom frequently during the night. This, along with the fatigue that is present in general, can lead to a stressed, emotional, exhausted expectant mother. Do not try to exercise on the days you have not slept well. You might also notice increased nausea on those days. Try to take naps if you can, and go to bed earlier at night.

Back and Pelvic Pain in Pregnancy and ExerciseBack and pelvic pain in pregnancy is very common and can be a significant concern in athletic pregnant women. Most pregnant women experience some type of back or pelvic ache or pain at some point in their pregnancy. Occasionally, pregnancy-related back or pelvic pain can continue beyond pregnancy; therefore, it is best to do the most you can to prevent it from becoming severe. Fortunately, as an active, strong woman, you are at less risk of serious back pain.

There are many types of back pain in pregnancy. Most is felt low in the middle back and pelvis, although it can be one sided or in the middle back. Some only get pain in the evening or at night. Back and pelvic pain is related to hormones, biomechanics, circulation, posture, and activity level.

Pregnancy hormones have multiple roles in the cause of back pain. They cause water retention in the tissues and ligaments, putting pressure on not just these structures but the joints as well. Also, the hormone unique to pregnancy, relaxin, leads to the pelvic loosening that is needed for childbirth. This hormone and the increased movement in the pelvis that occurs can cause pain at the sacroiliac joint and in other ligaments of the spine. Occasionally, the abdominal muscles can split (diastasis recti), compromising spine and abdominal stability. Stability problems in the back and abdomen can lead to increased risk of back pain. Strengthening surrounding and supporting muscles before and throughout pregnancy protects these looser structures and can prevent pain related to changes in stability.

Relaxin, the Hormone of Pregnancy

Causes loosening of ligaments and joints

Increased flexibility starts in the second trimester

Remains in the body for four to six months after pregnancy

Posture is a factor of back pain that can be modified. Maintaining good posture reduces the increased arch in the lower back that is so common to pregnancy. Muscles can get fatigued trying to hold certain positions, causing increased pain at the end of the day. Toward the end of pregnancy, you might walk a little differently or get out of a chair by leaning farther forward or twisting. Strengthening exercises to keep the spine and abdominal muscles strong will prevent body positions that cause more problems. Keeping your legs and core as strong as possible will prevent compromising movement patterns.

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